Pharmacy Benefit Manager (PBM) Legislation Updates and Guidance
This section provides timely updates on state and federal legislation, Division of Insurance bulletins, and regulatory guidance relevant to pharmacy benefit managers (PBMs) operating in Colorado. Here, you'll find official interpretations, implementation timelines, filing instructions, and compliance resources to support your obligations under current law. PBMs are encouraged to check this page regularly to stay informed of key deadlines and policy changes that may impact contract terms, reporting requirements, and market conduct expectations.
Regulation 4-2-104 Concerning Disclosures of Prescription Drug Contract Terms to Policyholders by Carriers and Pharmacy Benefit Managers
Guidance for Regulation 4-2-104
Guidance for Regulation 4-2-104
Contract Term Disclosures and Attestation Requirements
This update is intended to assist carriers and PBMs in preparing for compliance ahead of the first required filing and clarifies expectations around timing, plan year applicability, and filing structure.
What’s New:
Attestation Deadline Extended:
The first required attestation under Section 6 of the regulation is now due September 1, 2025. This is an extension of the originally anticipated timeline to provide carriers and PBMs more time to comply.
Plan Year Clarification:
The attestation and disclosure requirements apply to Plan Year 2025, covering the period from January 1, 2025, through December 31, 2025. The Division confirms that both the disclosure (Section 5) and attestation (Section 6) provisions are tied to this plan year.
Annual Attestation Schedule:
Beginning with the Plan Year starting in 2026, annual attestations will be due on June 1 of each year.
Separate Filings by Market Segment:
Each filing must meet the requirements of Regulation 4-2-104 for that specific segment.
Carrier Responsibility:
While carriers may allow PBMs to submit contract term disclosures on their behalf, carriers remain ultimately responsible for ensuring full compliance with all provisions of Regulation 4-2-104.
For more information, please contact the PBM Enforcement Division at dora_pbm_compliance@state.co.us.